Correlation of orbital computed tomographic findings with office probing and irrigation in 17 patients after successful and failed dacryocystorhinostomy

PURPOSE: To investigate the role of orbital computed tomography (CT) in the evaluation of patients after dacryocystorhinostomy (DCR). METHODS: Computed tomography scans of patients who underwent both successful and failed DCR were examined to determine the relationship of the soft-tissue changes to the surgical ostium, and the findings were correlated with postoperative results of office probing and irrigation. RESULTS: After a successful DCR (n = 7), a patent fistulous tract was confirmed by office probing and irrigation. A characteristic "Y-on-its-side" configuration of the soft tissue was noted on a CT scan. Total occlusion of the osteotomy by soft tissue on probing and irrigation corresponded to a mucocelelike soft-tissue density with a central lucency and soft-tissue obstruction (n = 2). Total occlusion of the osteotomy by inadequate excision of bone and adjacent soft tissue, visualized by CT imaging, was confirmed by palpation of bone by office probing (n = 1). Partial obstruction on probing and irrigation was associated on a CT scan with an increased soft-tissue density (n = 4) and bone in the region of the osteotomy (n = 3). CONCLUSIONS: Computed tomography allows visualization of a patent fistula after successful DCR as well as soft-tissue or bone obstruction of the surgically created fistula after failed DCR. When combined with probing and irrigation, CT helps to formulate a surgical plan after failed DCR.